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Kidney Week

Abstract: PO2508

Effects of Arteriovenous Fistulas on Outcomes of Kidney Transplant Recipients

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Caliskan, Yasar, Saint Louis University, Saint Louis, Missouri, United States
  • Dirim, Ahmet Burak, Istanbul School of Medicine, Istanbul, Turkey
  • Mirioglu, Safak, Istanbul School of Medicine, Istanbul, Turkey
  • Oto, Ozgur Akin, Istanbul School of Medicine, Istanbul, Turkey
  • Yazici, Halil, Istanbul School of Medicine, Istanbul, Turkey
  • Demir, Erol, Istanbul School of Medicine, Istanbul, Turkey
  • Safak, Seda, Istanbul School of Medicine, Istanbul, Turkey
  • Guller, Nurana, Istanbul School of Medicine, Istanbul, Turkey
  • Sever, Mehmet S., Istanbul School of Medicine, Istanbul, Turkey
  • Lentine, Krista L., Saint Louis University, Saint Louis, Missouri, United States
Background

Arteriovenous fistulas (AVFs) may exacerbate cardiovascular events (CVE) after kidney transplantation (KTx). We aimed to investigate the long-term effects of AVFs on KTx outcomes.

Methods

Prevalent 168 recipients were categorized at median 2yr. after KTx: recipients with functioning AVF (fAVF) (n=73), recipients with non-functioning AVF (nfAVF) (n=62) and recipients without AVFs (noAVF) (n=33) on pre-KTx peritoneal dialysis or underwent preemptive KTx. Baseline characteristics, echo findings and endothelial function were compared. During a median 11yr. follow-up after enrollment, CVE were defined as acute coronary syndromes or cerebrovascular accidents; additional outcomes included eGFRs at baseline and end of follow up, graft failure and death.

Results

Demographic, clinical, laboratory and echo characteristics and endothelial function at enrollment were not significantly different across all groups (Table 1). During follow up, CVE occurred in 9 (12.3%), 5 (8%), and 4 (12.1%) patients in fAVF, nfAVF and noAVF groups, respectively (p=0.70). Groups were comparable regarding graft and patient survival rates (p=0.13 and p=0.87, respectively). During follow-up, functioning AVFs thrombosed in 5 (7%) and were surgically closed in 20 (27%) patients in fAVF group. CVE rate was similar in patients with thrombosed (20%), closed (5%) and still functioning (15%) AVFs (p=0.47). Patient and graft survival rates were significantly lower in recipients with still functioning fAVFs (77% and 73%, respectively) compared to fAVF patients with thrombosed (100% and 100%, respectively) and closed (100% and 95%, respectively) AVFs (p=0.05 and 0.03, respectively).

Conclusion

Long-term CVE rate is similar in KTx recipients with and without patent AVFs. In a subgroup of KTx recipients with functioning AVFs, closure and thrombosis of AVFs may be associated with higher rates of patient and graft survival.